LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Friday, December 26, 2008


But the thrill we've never known
Is the thrill that'll get you when you get your picture
On the cover of the Rolling Stone

--Dr. Hook & the Medicine Show,
“On the cover of the Rolling Stone” 1973

So last week I got my smiling face on the cover of the rolling stone, as it were. The good folks at DiabetesDaily have been interviewing those of us who write about diabetes on the internet.

You can check it out at

That was a pretty good thrill.

Friday, December 19, 2008

Looking for trouble

I was expecting trouble, so I had my eye on the Girl.

A really cool feature of the current incarnation of the Guardian is the ability to leave the screen on all of the time. To do this go Sensor > Sensor Setup > Edit Settings > Graph Timeout > set to None. See how simple Med-T makes their menus?

The device company mid-set of their menus aside (unlike, say, CoZmo or OmniPod who remember that real-live-breathing-human-beings have to live with these devices 24-7-365), this ability to leave the screen on all the time, where I want it, is a really great feature. One that I hope the next-gen pump will have.

As a quick reminder, Guardian is higher up the evolutionary scale than the Para-pump, which shuts off all visuals after a minute or so. Guardian is also better educated and sophisticated. Damn, do I love a smart woman! Guardian has 6 and 12 hour graphs. Poor old Para-pump only has 3 and 24. Guardian has also spent some time at Delphi U, learning to predict the future. Kid you not, the damn predictive alarms are frighteningly accurate. Poor old Para-pump can only tell you the eagle has landed once it has crashed. Yep, it only has threshold alarms.

This is an important technological difference, as CGM systems all suffer from sampling lag. If you are new to CGM, I want to fill you in on why this is. If you are a vet or highly informed person, just bear with me for a minute. Continuous monitoring isn’t continuous at all, any more than movie film is continuous. In movies we are really looking at a series of 35mm slides displayed at a rate of 24 frames per second. In CGM we are really looking at a series of blood sugar readings displayed at a rate of 5-frames per minute for Med-T and DexCom, or 1-frame per minute for the Abbott Navigator.

Not technically continuous, but I challenge you to finger stick 288 times per day, which is what you get with Guardian. But the bottom line is that a lot can happen in five minutes if your blood sugar is changing rapidly. Add to that the second problem: CGM sensors “live” in the water between your cells called interstitial fluid. Not blood. Sugar levels change in the blood first, making interstitial fluid data a hair dated—not unlike the difference between forearm and fingertip testing.

And last but not least, the whole foundation is built on sand in the first place. You calibrate a CGM with a meter….and we all know how far off those little SOBs can be…

So back on track. The point of all of this is that a threshold alarm isn’t a whole lot of help: to have it liberal enough to warn you of trouble brewing you have to set it so high you are plagued by nuisance alarms all the time when you are low-stable. A predictive alarm on the other hand, tracks rate of change and then projects where you are likely to be down the road. It elegantly compensates for the inherent weaknesses built into the CGM universe.

But does it always work. Not 100% of the time. Which is why, when I’m expecting trouble, I keep an eye on the Girl. Which is why I’m so tickled that I don’t have to press any buttons to do just that. I just glance down at my waist and I know more or less where my blood sugar is. I also, at a glance, can see how that relates to where it has been over the last six hours. Like a quick glance at a watch tells you the time without any real brain power being used; a quick glance at Guardian’s face tells me if it is high time, low time, or just the right time—blood sugarwise.

This is what I love about CGM: data with context. Using a meter you might know that you are at…oh, I don’t know… let’s say 108. Good number? Depends. Depends how much insulin you have coursing through your veins and how long it has been around. Depends on if it was 109 ten minutes ago. Or 158.

Numbers are worthless without context.

So back to girl trouble. Oh, no. Wait. This was more woman trouble. To be specific, an elderly lady who I love very much: my Mother. My Mother has moved to town. That’s what caused my most recent nasty hypo.

Well, it wasn’t so much her arrival (stress makes your blood sugar go up). I was helping her get set up. Moving wide easy chairs through narrow doors. Carting 29.34563 tons of books, setting up appallingly heavy Victorian furniture. Basically doing stuff my poor diabetic body just isn’t equipped for. I think you all know I’m not exactly Team Type-1 material. The hypo was predictable, even without predictive alarms. Not only was it predictable; it was inevitable.

Even so, it was a sneaky little bastard. Came on fast and hard toward the end of the day. I had even scarfed down a large burger a about five potatoes worth of French fries as anti-hypo meds. But it didn’t work. They hypo came anyway.

Of course I didn’t feel it coming. I never do. And the Girl didn’t give me an alarm. But I was watching. Watching the “trace,” the life-support-like thin black line on the Guardian’s graph. The heart-beat of my blood sugar.

I had been pretty stable in the 150s. Then the trace shifted. 140s. 130s. 120s. Ut-oh.

Finger stick on a FreeStle Lite (love that strip-port light!) finds me at 70. Crap. Bush-whacked again!

So I’m wearing a loaner Cozmo 1800 at the moment. I dial in the 70 into the Hypo Manager and it spits out my homework: eat 20 carbs (by the way, this turns out to be excellent advice, I had a nice recovery with no rebound hyper). So I drink a bottle of Fox Fluid and eat half a cherry slice. Then I lay down in a box to wait my fifteen minutes.

In a box, I said. Not coffin.

So I’m laying on the floor. Head and torso inside a wardrobe box. Feet and legs on the oriental carpet of the half-empty living room. I’ve got my top half in the top half of the box, because I’ve got all my Rio in the bottom half of the box. He fell in love with the box as soon as he saw it. “Daddy, how do you spell ‘home sweet home?’”


And Rio starts writing this on the box with a magic marker.

You don’t have to have gone to Delphi U to be able to make one prediction: the evolution of Med-T tech. Consider. First came the insulin pump. Then the garage door opener Guardian. Then the Para-pump. Then the new, smart Guardian. So next? Presumably a Smart Pump. One with predicative alarms. Hopefully LOUDER ones. And hopefully ones that both squawk and vibrate. I’ve also got my fingers crossed that I’ll be able to leave the screen on all the time. So I can glace at my dash board without having to press a button.

But somewhere in California, I just know some fool is thinking that we’ll plough through batteries too quickly if we leave the damn screen on all the time. The same batteries that keep the insulin pumping. So to protect us from ourselves, I fear our options will be taken away from us.

But come on, they are AAA. The world’s most common battery. You can get ‘em anywhere. You can carry a spare. Please don’t take my Kodachrome away!

Inside the box, Guardian predicts the low I just treated. Welcome to the party, Girl. Still to be fair, if I hadn’t expected trouble she would have warned me before I passed out.

A few minutes later the Cozmo beeps at me: time to check your blood sugar.

105. Sweet recovery. I’m back in the game, and no worse for wear.

What? There are how many boxes of antique glass?!

Maybe I’ll stay in the box for a while…

Friday, December 12, 2008

One if by land…

Sara squinted, staring at my chest, “It’s cool. How old is it?”

I’m not sure exactly, the eBay description just said ‘vintage.’

“Is that, like, antique?” Sara turned 21, like, 45 seconds ago.

No ‘vintage’ means it was made after I was born, but before you were born.

“Ah, I see…”

I was showing Sara--one of our half-time-at-the-clinic in scrubs Medical Assistants; half-time-on-one-of-the-ambulances in combat boot and black cargo pants EMTs--my latest eBay find.

Nope, not a pipe.

Nope, not a microscope.

Guess again.

Yeah, you got it. I got a really cool old medic alert necklace. Regular readers know I’m pretty passionate about this subject. Regular readers also know I have a medic alert tattoo. So why would I buy a necklace?

Actually, I haven’t worn any jewelry since I got the tattoo. Maybe I just needed a break. Maybe it was time to wear more than just a tattoo. Maybe I’m just a sucker for something that strikes my sense of beauty.

But here’s how it went down: a while back, near my birthday, I spotted a three-foot carved wood caduceus on eBay. The detail was stunning. It was bought in Germany about 25 years ago by someone in the service. Would have looked great on my wall. I bid as high as I dared, plus about 75 bucks more, but some low-down dirty snake beat me by five bucks. I hope it looks good on his wall (not).

Anyway, every once and a while I search eBay for “caduceus” hoping that it freaks out his wife so much she lays down one of those “the snakes or me” kind of ultimatums. No such luck so far, but I stumbled onto this beauty. Technically, this one is a staff of Hermes, but who’s counting? (Note for detail freaks: the caduceus has two snakes on a winged staff, and the staff of Hermes has one snake on a staff with no wings. Technically, the single-snake model has deeper roots in the history of medicine; but in the American tradition of more is better, the two snakes with the winged staff have been the de-facto symbol of all things medical in the USA for over a hundred years.)

I’ve seen a lot of various types of medic alert stuff for us D-Folk, but never one quite like this. It is silver with white and red enamel fill. One of my patients spotted it and recalled that her grandma wore one like it (Type-2 is an inter-generational affair around here).

I love the look of this pendant, and it has a good vibe. I gotta admit, I love the caduceus/Hermes symbol. For most of my life I thought it was the private property of docs and medics and the like. But most medic alert stuff also has the symbol. That’s when I realized: IT IS OURS too. Just like it is OUR diabetes. I’ve adopted the snakes and winged staff with no guilt, symbolic of the way I think we D-folk need to take our diabetes back from the medical folks, the insurance folks, and the government folks. Diabetes is a self managed disease. Time we all get off our duffs and take it back. Time we manage it with the HELP of all of the folks above. Stop taking orders and start taking responsibility.

And one of our responsibilities is to wear something that lets the authorities know who and what we are if we get into trouble.

Recently my buddy Fox passed through on her appointed rounds. Fox, as you may recall, is a meter rep who calls on my clinic and is also my kinswoman: a fellow T-1.

Where’s your alert jewelry? I ask her every time she visits.

To which I get the usual litany of excuses. Where upon I give her my stock lecture about traveling T-1s and hypos and cops beating the crap out of our hypo kinfolk (and this was before the latest high profile incidents on CNN).

But I think it was the flu shot that finally gave me creditably with her. At the start of flu season I basically told her she could spend the rest of her natural life in my office, or get a flu shot. She opted for the flu shot, which is kinda of a shame because she would have done a lot for the décor of my office. Anyway, her hub caught the flu a few weeks later, suffered miserably, and she got off without so much as a sniffle. I guess she figured if I was right about the flu, maybe I was right about the medic alert stuff.

I got an email from her: “Hey, I am the proud owner of a fancy new medical alert bracelet!”

I asked her to send me some pics of her new bling. Here is the girly side…

….and the business side….

Nice. Fits her style. Might save her ass.

Meanwhile a D-mom who is a reader emailed me a pic of her son Zack’s new alert tattoo. It’s based on our open-source tat here. His is bigger than mine with some style tweaking to fit his own image. Two of my Peer Educators are planning tattoos too, but so far it’s all talk.

But tattoos aren’t for everyone. And bracelets aren’t for everyone. Necklaces aren’t for everyone either. Watches or watch bands aren’t for everyone. But for God’s sake choose one of the above. Bottom line: if you are diabetic (or a Person With Diabetes) you need alert jewelry. I’m pretty sure it is in our Code of Ethics somewhere; which is part of the membership packet you were mailed along with your glucometer when you joined our club.

If you don’t do it for yourself (and why wouldn’t you?), do it for your Type-3s who love you even when you are stupid. Or hypo. Or both.

Now in one of the recent high profile D-tasing incidents, our poor kinsman had a necklace on, but it was hidden by his clothes. Which brings me to the indispensable accessory for your car: the Diabetic Driver sicker from which is money--and not much of it--in the bank. This is a cool-looking sticker that shines at night like those little reflectors by the side of the road. Bottom line: when the cops flash their mag-lights in the windshield (while whipping out their tasers) it’ll glow: don’t shoot me, I’m sick, not stoned.

So here’s the deal: show me your alert! Email me a picture of how you show your colors to the world. I’ll pull together a nice little album and, like, post it.

PS: Almost forgot, I have a correction to make. Jonah is right in his comments last week. That’s what I get for doing math in the middle of the night. By candlelight. While drunk.

I mixed my apples and oranges on my clever little analogy folks. T-1s run 5% of diabetic population. But by taking out five pennies in my example, I increased us from 5% of a sub-population to 5% of the total population, thus I greatly increased our population. Yes, it was a blatant power grab on my part.

So what I should have done was set 8 pennies aside for all D-folk, both T-1s and T-2. That ends up changing the answer on the word problem, but it still boggles the mind.

Think how much power we’d have if we voted as a block!

PPS: Oh, and BOOK, BOOK, BOOK! I spent Friday, Saturday, Sunday, and Monday reviewing galleys. Exhausting. Exciting. I slept for 20 hours afterwards. No shit.

Anyway, I mention it (again, shameless, I know) because the pre-order price is going up! Ya only got a couple more days to get the 25% off, then the discount gets less, and less, and less as we get closer, and closer, and closer to the release date. Clever, these publishing folks. I’m told if you pre-order you get a little surprise gift too.

Friday, December 05, 2008

By the numbers

Let’s say I have one dollar. Hey, it could happen.

Now let us assume that it is in pennies. So now I have 100 pennies spread out in front of me.

Take five out and set them aside. That’s me and my kind. The Type-1 cents.

Now take out eight more pennies out and set them over there. Those are the Type-2 cents.

Now take out take out twenty five more and put them, oh, I don’t know, over there on the right somewhere. According to new numbers released by the Centers for Disease Control a few weeks ago, those are the pre-diabetic pennies.

How many pennies are left? (Don’t you just hate word problems?)

Answer: there is 62 cents left.

That’s diabetes today. Nearly 4 out of every ten people you meet on the street today either have diabetes, or are developing it. And that’s just U.S. pennies. There are also pounds, and euros, and yens, and…..

So………how does that compare to other epidemics?